Minithoracotomy versus ministernotomy aortic valve replacement

Objective: It is debatable which minimally invasive strategy is better for aortic valve replacement (AVR). This study aims to compare the perioperative outcomes of AVR through right anterior minithoracotomy (RAT) versus ministernotomy. Methods: A series of 162 consecutive patients who underwent minimally invasive AVR (107 RAT and 55 ministernotomy) from August 2013 to May 2022 were evaluated. Primary outcome measured was perioperative mortality. Secondary outcomes measured were operative time, perioperative stroke, and blood loss. Results: Majority of patients were of low operative risk (93.5% vs 89.1%) and overweight/obese (body mass index ≥ 25 kg/m², 76.6% vs 65.5%). No cardiac mortality or major morbidity including stroke was observed in either group. RAT was associated with lower blood loss (mean hemoglobin level at time of hospital discharge, 111.8 g/L vs 104.4 g/L, p = 0.02). There was no statistical difference in transfusion rates between the groups (11.2% vs 14.5%, p = 0.6). In isolated AVR, operative time was slightly shorter with ministernotomy (median bypass time, 123 minutes in RAT vs 113 minutes in ministernotomy, p = 0.02). There was a statistically significant decline in both cross-clamp (p = 0.005) and bypass time (p = 0.004) over the study period. Conclusions: Both minimally invasive AVR methods produced good clinical results. No significant difference was observed in mortality or stroke with either technique. RAT AVR may be preferred over ministernotomy due to its sternal-sparing effect despite being a slightly longer operation while one of the advantages of ministernotomy is easy allowance for concomitant procedures. Graphical Abstract: (Figure presented.)